Mr Andrew Davies (consultant oesophagogastric and general surgeon): So you've heard the basics of enhanced recovery we're now going to go into the details of what this involves for patients having surgery for cancer of the oesophagus and stomach.
Enhanced recovery is about teamwork. It's about all the healthcare professionals involved in your care working together to help you recover quickly and safely following surgery. There are a variety of operations we perform for these cancers and each of them is individually selected for you. Increasingly we're using laparoscopic or keyhole surgery to help you recover quicker.
During this video you'll meet some of the team that will be involved in your care. We understand that having surgery to have part of your oesophagus or stomach removed can be daunting and we hope that this video helps you to understand the processes a little better.
Dr Nick Maisey (consultant medical oncologist): Cancers of the stomach and oesophagus are relatively rare. The misconception is that these are cancers that can't be cured but actually a lot of the patients that we see here go through curative treatment meaning that we give various treatments to get rid of the cancer to allow the patient to live a normal life eventually.
So we try to individualise the treatment for you. So depending on what we decide in our joint meetings with the wider team, everybody's case is discussed individually, but typically patients will have a period of chemotherapy before surgery and then often after you recover from your surgery we may decide to give another month or two of chemotherapy treatment afterwards.
Along with chemotherapy, quite often radiotherapy treatment may be offered as a treatment for your cancer and that can be given sometimes before the surgery but often can be given after the surgery as well.
Most of the treatments that we give with chemotherapy is all outpatient based. The chemotherapy that we give to patients is given over at our Cancer Centre on the Guy's campus and when you do have the treatments you'll be in and out in the same day so you won't need to spend a night in hospital.
We're very keen to always make progress in the way that we treat patients and an integral part of that is being involved in research and development of new therapies and new ways of fighting cancer. You may be asked to be involved in a clinical trial to try to push forward our knowledge of cancer treatment.
Georgia Mundle (upper GI clinical nurse specialist): The patient journey will include a CT scan or a camera test, following that you'll have a PET scan as well. You will then be discussed at our MDM meetings on a Wednesday morning. Following that we'll meet you in clinic to discuss what the next step is.
After your day of tests you will be seen by the consultants who will give you information about whether you need to have chemotherapy or primary surgery. When you come in to meet us you will be greeted by various members of the multidisciplinary team, so that includes a physio; a dietitian; your consulting surgeon and also myself as the enhanced recovery nurse.
Tony Whiffen (oesophageal cancer patient): I saw the consultant surgeon having had a range of different tests. The diagnosis was oesophageal cancer and the recommendation was chemotherapy, surgery, and then some more chemotherapy. The enhanced recovery pathway was discussed at the initial meeting with the consultant surgeon. It sounded quite an attractive idea to optimise or reduce the time in hospital, spent on the ward.
Mr Andrew Davies: Some patients want to know everything about their proposed operation whereas others prefer not to know the details. Either way your team will be very happy to go through things with you in as much or as little detail as you wish but fundamentally to explain what we're planning to do and why.
Annie Coombs (senior specialist UGI dietitian): Soon after diagnosis you'll see myself or one of my colleagues. We'll be able to advise you on diet and building your strength and get you ready for your surgery. It's really important that you stay as weight stable as possible to build up your strength. In order to do this you need to have a varied balanced diet. If you are struggling to eat and drink prior to your surgery, we will be able to give you some ways to improve your diet and build your overall strength.
Gemma Tham (clinical specialist physiotherapist): Physiotherapists teach breathing exercises to patients before operations because one of the most common side effects of these surgeries are chest infections. So it's really important that you are used to doing the breathing exercises and we'll teach you these very early on so that you can practice all the way through your treatment pathway.
We will do a holistic assessment and then we will give you advice about exercise during your chemotherapy. We'll also give you some advice about managing fatigue.
We'll try to encourage you to give up smoking because that will also help you in your future recovery.
We aim to give you a structured exercise programme and although some people don't really like the idea of exercise we'll try to find something that you'll enjoy doing because it's important that you participate in your exercise programme during your treatment.
Fatigue is a very common side effect of chemotherapy and some people find that the more tired they get, the less they do and the less you do, the less tired you are and you you're less likely to sleep well. So it's important to pace your activities and keep as active as possible.
Tony Whiffen: I made sure I was fit and well prior to the surgery and that I'd eaten very well for a period of time. I did everything that the leaflets and booklets suggested that I should do.
Kelsie Gurney (sister): You'll either be admitted the night before your surgery or sometimes on the morning of your surgery. You'll be reviewed by the doctors, by the anaesthetist and the nursing staff when you're admitted. You'll be taken from the ward to the anaesthetics room where you'll be seen by the doctors and nurses there and after the anaesthetics room they'll take you into theatre.
Tony Whiffen: On the actual day we were consented so they described the operation in detail and what that would entail.
Dr Charlotte Taylor (anaesthetic consultant): I'm one of the anaesthetists that look after patients having upper GI surgery. Our job is to make sure you're safe when you're asleep having your operation. Whilst you're asleep we put lots of different drips in that will be there when you wake up. Our job is also to make sure that your pain is controlled after the operation. We do this by putting in epidurals before you go to sleep or by a paravertebral block that is put in when you are asleep. We run this along with the patient controlled analgesia pump, a PCA, which is morphine through a drip with a button to press when you need the pain relief.
Mr Andrew Davies: The day of the surgery is often more stressful for relatives. To some extent you come into hospital have a general anaesthetic and go to sleep and everybody else does the worrying for you. It's after the operation when all of the team kicks into action to start your recovery that your engagement is crucial.
Kelsie Gurney: After surgery you'll spend one night and overnight intensive recovery and then you'll be moved up to the ward. You'll be reviewed by your regular doctors, nurses, physiotherapists and dietitians. Everyone will be working together to make sure you have the smoothest recovery possible with as few complications as we can.
You'll have quite a few drips and drains immediately after surgery. Over the next few days you will start to lose those. You will definitely start to feel more like yourself around day four or day five after your surgery when we're able to take some of those out.
Tony Whiffen: I was on a step-down intensive care ward for a night. I think the first person I saw was a physio on the second day. Obviously I saw doctors and the consultant surgeon and the consultant nurses. The physio took me for a walk around the ward and it was very encouraging actually to be able to have a walk around and feel that you're on the route to recovery already, so soon.
Annie Coombs: Immediately after surgery you won't be allowed to eat and drink for anywhere between three and five days. After this time you get sent for a test to make sure that you've got a watertight seal.
Following this, if that's all okay, then we start you on a step by step gradual progression with your oral intake. This usually starts with clear fluids like water and then you progress the next day on to something called free fluids this is things like milk, ice cream, soups, jelly, yoghurts and if that's all okay then you progress the next day on to a level 6 soft and bite-sized diet.
You'll be provided with all the relevant literature to support this. Your portion sizes will be reduced. The dietitians will recommend that you eat little and often.
Gemma Tham: The physiotherapy team will come to review you the day after your operation and we will help you to get out of bed that morning. We'll also teach you some breathing exercises and it's really important that you can cough. If you have any pain you must tell us. You must be able to deep breath, cough and move. This will help to prevent chest infections and other complications such as clots in your legs.
Tony Whiffen: The dietary advice was very clear and carefully developed because there is a change to the stomach capacity and therefore it's fundamentally about eating frequently but smaller portions.
Gemma Tham: We'll give you personalised advice about returning to all the normal activities that you want to do including returning to sport and returning to work.
Kelsie Gurney: There is an expected date of discharge with the enhanced recovery programme but everybody's needs are different after having surgery and we'll make sure that we speak with every member of the team and with you and your family to make sure that you're ready to go home at the right time for you.
Tony Whiffen: I expected a period of two weeks at least and I was discharged after nine days. I thought that the teams of physios, consultant surgeons, are outstanding and world-class and when the NHS works together when someone is sick, it's quite a powerful machine. It really does work and coordinate very well. I'm very impressed with the treatment I got and the standard of care.
Georgia Mundle: We understand that having surgery can be quite daunting for you and your loved one. We are here to make your journey a bit easier.